The Incidence And Influencing Factors Of Gastrointestinal Diseases In Liver Transplantation Recipients With Hepatitis B Associated Liver Disease

Objective: Gastrointestinal diseases have plagued patients after liver transplantation for a long time,and affected the quality of life and even the survival time of recipients of liver transplantation.The results of screening were discussed and the influencing factors were analyzed in order to improve the survival time and the quality of life of liver transplantation recipients with hepatitis B related liver disease.Methods: Subjects in the study were patients with hepatitis B-associated liver disease underwent orthotopic liver transplantation in the Affiliated Hospital of Qingdao University from March 2004 to February 2018,32 patients were chosen to perform electronic colonoscopy and 39 were chosen to perform electronic gastroscopy as the transplantation group.At the same time,the hepatitis B surface antigen positive patients who underwent electronic gastroscopy and electronic colonoscopy were selected as the hepatitis B group and the physical examination group was regard as the control group and matched(3:1 ratio).The incidence of gastrointestinal diseases in patients having same age and sex were compared.Clinical data were collected such as age,gender,pre-liver transplantation basic diseases,operative time,smoking history,drinking history,body mass index,diabetes mellitus,hypertension,hyperlipidemia,family history of digestive system tumors and serum concentration of immunosuppressive agents before endoscopic examination,.The matched cases were matched at 1:3 and the same age was compared.The related factors were analyzed by univariate analysis,and the risk factors with significant difference were further analyzed in logistic regression to initially explore the influencing factors of gastrointestinal diseases after liver transplantation.Results: The results of gastroscopy showed that the incidence of chronic atrophic gastritis in transplantation group was significantly higher than that in hepatitis B group and physical examination group(79.49% vs 61.54%,79.49% vs 60.68%,P< 0.05).The incidence of reflux esophagitis in the transplantation group was significantly higher than that in the control group(23.08% vs 9.4%,P= 0.027)and higher than that in the hepatitis B group but there was no significant difference(23.08% vs 12.8%,P> 0.05),The incidence of esophageal varices in the transplantation group was significantly higher than that in the control group(17.95%vs 0;P=0.003).The incidence of colorectal polyps in the transplantation group was higher than that in the hepatitis B group,but there was no significant difference between the two groups and physical examination group(62.5% vs 55.21%,62.5%vs 47.92%;P > 0.05).Univariate analysis showed that age was the risk factor for chronic atrophic gastritis,family history of digestive system tumor was the risk factor for reflux esophagitis.The risk factors for colorectal adenoma were history of smoking(P= 0.004)and immunosuppressive concentration(P=0.001).Logistic regression analysis of age,smoking history,family history of digestive system tumors and immunosuppressive concentration showed that age was the independent risk factor for chronic atrophic gastritis(P= 0.048,OR= 1.158).The independent risk factors for reflux esophagitis were family history of digestive system tumors(P=0.029,OR=7.556),and the independent risk factors for colorectal polyps were history of smoking(P=0.048,OR=7.427)and the latest immunosuppressive drug concentration before endoscopy(P= 0.029,OR=1.788).Conclusion: The incidence of atrophic gastritis(79.49%),reflux esophagitis(23.08%)and colorectal polyps(62.50%)in hepatitis B liver transplantation recipients were increased.Age is a risk factor for chronic atrophic gastritis after liver transplantation.Family history of digestive system tumors is a risk factor for reflux esophagitis after liver transplantation.History of smoking,increased concentration of latest immunosuppressive agents is a risk factor for colorectal polyps after liver transplantation.In order to improve the quality of life of liver transplant recipients,we should pay attention to the screening of gastroenteroscopy after liver transplantation.